hazards of anaesthesia g.k.kumar. defeniton danger/risk anesthesiologists patients
TRANSCRIPT
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HAZARDS OF ANAESTHESIA
G.K.KUMAR
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DEFENITON
DANGER/RISK ANESTHESIOLOGISTS PATIENTS
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HAZARDS FOR ANASTHESIOLOGISTS Fire & explosions Electrical accidents Pollutions by anesthetic agents Radiations Infections Incompatibilities / allergies Stress Chemical dependence
OR
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HAZARDS FOR ANASTHESIOLOGISTS PHYSICAL -ELECTRICAL -ENVIRONMENTAL -INFECTIVE -ALLERGY PSYCOLOGICAL -STRESS -DEPENDENCY
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Electrical accidents
Unsafe electrical configurations Types-macro shock -micro shock -loss of power supply to
gadgets Safe practices
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Electrical accidents Macro shock-Large voltage
current-Causes
tissue damages burns explosions
1ma perception
5ma harmless
10-20maMuscular contraction
50-100ma Pain, fainting
100-2500ma VF
>6000ma Resp.arrest
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Micro shock-Direct application of very small voltages to the heart thro’ electrodes
Allowable leakage thro’ electrodes-10µA
>50µA-VF occurs
Electrical accidents
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Electrical accidents - Safe
practices
1. Proper grounded equipments(3pin)2. Don’t connect the pt to the OR grounding
sources3. Electro cautery: large grounding pads, to be
kept well away from electrodes & PM4. Use bipolar5. Reset the pace maker to regular
mode(asynchronised)6. Keep ready pharmacological pacing-
Isoprenaline7. Good maintenance of equipments
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Pollution by anesthetic agents
Risks Recommendations Remedies
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Pollution by anesthetic agents
Risks- Real? Or Mystiques? -abortions -congenital abnormalities -malignancies (liver) -behavioral problems(N2O)
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Pollution by anesthetic agents
Recommendations Upper limits N2O 25ppm
Halogenated agents
2ppm
Halogenated agents with N2O
0.5ppm
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Pollution by anesthetic agents
Remedies Scavenging systems Closed circuits Anti spill devices Avoid agents
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Radiation hazards
Risks Recommendations Remedies
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Radiation hazards
Risks Ionizing radiation-X’ray, radioactive
isotopes Formation of free radicals, ionizing
molecules Damage/destruction of cells,
Ch anomalies, malignancies.
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Radiation hazards
Risks Non-Ionizing radiation –laser
Disruption of electrons from one orbit to others, but with in cells
Tissue damage Laser plums formation (contain viable
bacteria,HPV DNA,HIVproviral DNA)
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Radiation hazards
Recommendations Max. allowable exposure/yr<5Rem during pregnancy-
500mRem 0ne X’ray-25 mRem Natural exposure cosmic rays-
40mRem
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Radiation hazards
Remedies for ionizing radiation Scattered rays inv. Proportional to
(distance)2 from the source Best way of protection-physical
separation (6 ft = 9 in concrete = 2.5 mm lead) Protective lead aprons (o.25-o.5mm)
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Radiation hazards
Remedies for non-ionizing radiation Radiation intensity not decreased to
distance in an average OR. Proper gaggles Laser plum to be removed by
effective scavenging systems removes particles ≥o.1µm (filters ≥0.5µm).
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Infections
Physical spread-HSV,CMV Blood borne-HIV,HBV,HCV Air borne-Mtb
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Infections Blood borne diseases thro’ Needle stick
injuries- HIV:0.3%, HBV:3%, HCV30% 32% had at least 1 NSI in the preceding 12M.
(only half of them took treatment). More risk with hollow-core & large bore NSI more in non dominated hands NSI more during disposal of contaminated
needles. Anesthesiologists have risk for occupational
infection during 30years of exposure-0.045-4.5%
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Infections-HIV Health care workers contribute 5%
of total cases 4% of emergency department pts
are unidentified cases. Pts considered infective if both
screening (ELISHA) & confirmatory (western blot, indirect fluorescent ab) tests are positive.
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Infections-HIV
54 reported cases of occupationally acquired HIV(1998).
88% of them had H/O NSI ? Quantity of inoculums- ( a case
report :100-200µml of blood thro”i.v. produced HIV).
Risk for the pts- 6 cases reported.
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Infections-HBV Non immunized health care workers
higher risks 17.8% 0f seropositive among
anesthesiologist 30% became positive after 11 years of
exposure Disinfectants & gloves are not
completely protective- viruses viable for >14 days in needles, gloves, &surfaces.
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Infections-HCV
No immunization available No specific treatment available Advice: serologic monitoring for
HCV & LFT 3-6 monthly.
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Infections
Management of occupational infections.SAFE PRACTICE1. Protective equipments2. Washing methods3. Disposal methods
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Infections -CDC recommendations Universal precautions-1980
-considering as all pts, blood & body fluids are infective.
Isolation precautions-1996
-2 tier recommendations1. Standard precautions -to be followed
for handling all pts as UP.2. Transmission based precautions -for
handling pts known to be / suspected of being risks.
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Infections -CDC recommendations
Transmission based precautions Based on specific the properties of specific
pathogens Airborne precautions [measles,varicella,Tb] -to
prevent from small particles<5µm by specific filters air handling devices.-HEPA, Negative pr environment
Droplet precautions [HI-type b, mycoplasma, streptococcal pharyngitis, rubella]-to prevent from large particles>5µm, keep distance>1m
Contact precautions [HAV, HSV, viral conjunctivitis]
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Incompatibilities / Allergies
Latex allergy Type iv/ type I Risk groups :
1. Atopics,2. Spina bifida,3. Urogenital abnormalities ,4. HCW, 5. Rubber factory workers.
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Latex allergy Managements
1. Identification of risk groups2. Use latex free objects-latex free
environment 3. Tests:RAST[radio-allergo-sorbent test] SPT Sr.histamine Urinary histamine Sr.IgE Sr.compliments Sr.tryptase
Tests for anaphylaxis
Screening tests
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Latex allergyManagements-drug regimens Preoperative protocol:
1. Dipenhydramine -1mg/kg,po/iv,q 6hr at 13,7,1hr before surgery
2. Prednisolone -1mg/kg,po/iv,q 6hr at 13,7,1hr before surgery or hydro cortisone 4g/kg
3. Ranitidine - 2mg/kg po, 1mg/kg iv,q 12hr at 13,1hr before surgery
Postop protocol -drugs to be repeated for 12hrs
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Stress Inevitable, universal phenomenon
to which no one is immune Job related stress are unavoidable
but may be controlled 2 types-Unavoidable & Avoidable Unavoidable-professional stress Avoidable-sleep related
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Stress
Unavoidable Stress Professional Stress Co-worker relationships Work load Litigations Peer review Professional dissatisfaction Administrative responsibilities
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Stress
Avoidable Stress Sleep related-altered sleep
pattern, sleep deprivation Coincide with natural sleep
peaks[2-7a.m] Identification of sleep disturbances Regulations of working hours
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Chemical dependenceSelf administration of drugs & suicide rates are
high among anesthesiologist. Addiction :compulsive continued use of drugs
in spite of adverse, a chronic, relapsing condition resulting from long term effects of drugs on brain, due to molecular, structural, cellular, & functional changes.
Dependence: physical / psychological inability to control drug use
Abuse :use of drugs in detrimental way but not to the point of addiction. a pre addiction level, can easily quit. a voluntary act.
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Chemical dependence
Causes Stress Availabilities Curiosity for experimentation Drug potency Others-genetic predisposition
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Chemical dependence
Management Identification Intervention Referral Rehabilitation